ZEITLUPE enhances expression of PIF4 and YUC8 in the upper aerial parts of Arabidopsis seedlings to positively regulate hypocotyl elongation.

KEY MESSAGE: Microarray and genetic analyses reveal that ZTL induces the expression of genes related to auxin synthesis, thereby promoting hypocotyl elongation. ZTL is a blue-light receptor that possesses a light-oxygen-voltage-sensing (LOV) domain, an F-box motif, and a kelch repeat domain. ZTL promotes hypocotyl elongation under high temperature (28 °C) in Arabidopsis thaliana; however, the mechanism of this regulation is unknown. Here, we divided seedlings into hypocotyls and upper aerial parts, and performed microarray analyses. In hypocotyl, 1062 genes were down-regulated in ztl mutants (ztl-3 and ztl-105) compared with wild type; some of these genes encoded enzymes involved in cell wall modification, consistent with reduced hypocotyl elongation. In upper aerial parts, 1038 genes were down-regulated in the ztl mutants compared with wild type; these included genes involved in auxin synthesis and auxin response. Furthermore, the expression of the PHYTOCHROME INTERACTING FACTOR 4 (PIF4) gene, which encodes a transcription factor known to positively regulate YUCCA genes (YUCs), was also decreased in the ztl mutants. Genetic analysis revealed that overexpression of PIF4 and YUC8 could restore the suppressed hypocotyl length in the ztl mutants. Our results suggest that ZTL induces expression of YUC8 via PIF4 in upper aerial parts and promotes hypocotyl elongation.

Enhancement of hypocotyl elongation by LOV KELCH PROTEIN2 production is mediated by auxin and phytochrome-interacting factors in Arabidopsis thaliana.

KEY MESSAGE: Auxin and two phytochrome-interacting factors, PHYTOCHROME-INTERACTING FACTOR4 (PIF4) and PIF5, play crucial roles in the enhancement of hypocotyl elongation in transgenic Arabidopsis thaliana plants that overproduce LOV KELCH PROTEIN2 (LKP2). LOV KELCH PROTEIN2 (LKP2) is a positive regulator of hypocotyl elongation under white light in Arabidopsis thaliana. In this study, using microarray analysis, we compared the gene expression profiles of hypocotyls of wild-type Arabidopsis (Columbia accession), a transgenic line that produces green fluorescent protein (GFP), and two lines that produce GFP-tagged LKP2 (GFP-LKP2). We found that, in GFP-LKP2 hypocotyls, 775 genes were up-regulated, including 36 auxin-responsive genes, such as 27 SMALL AUXIN UP RNA (SAUR) and 6 AUXIN/INDOLE-3-ACETIC ACID (AUX/IAA) genes, and 21 genes involved in responses to red or far-red light, including PHYTOCHROME-INTERACTING FACTOR4 (PIF4) and PIF5; and 725 genes were down-regulated, including 15 flavonoid biosynthesis genes. Hypocotyls of GFP-LKP2 seedlings, but not cotyledons or roots, contained a higher level of indole-3-acetic acid (IAA) than those of control seedlings. Auxin inhibitors reduced the enhancement of hypocotyl elongation in GFP-LKP2 seedlings by inhibiting the increase in cortical cell number and elongation of the epidermal and cortical cells. The enhancement of hypocotyl elongation was completely suppressed in progeny of the crosses between GFP-LKP2 lines and dominant gain-of-function auxin-resistant mutants (axr2-1 and axr3-1) or loss-of-function mutants pif4, pif5, and pif4 pif5. Our results suggest that the enhancement of hypocotyl elongation in GFP-LKP2 seedlings is due to the elevated level of IAA and to the up-regulated expression of PIF4 and PIF5 in hypocotyls.

Perspectives of Nursing Students on Hybrid Simulation-Based Learning Clinical Experience: A Text-Mining Analysis.

Given the past limitations on clinical practice training during the COVID-19 pandemic, a hybrid format program was developed, combining a time-lapse unfolding case study and high-fidelity simulation. This study assesses the effectiveness of a new form of clinical training from the perspective of student nurses. A questionnaire was administered to 159 second-year nursing students enrolled in the "Basic Nursing Practice II" course. Text mining was performed using quantitative text analysis for the following items: (1) aspects that were learned more deeply, (2) benefits, and (3) difficulties encountered with the new practice format. The new clinical practice format enhanced participants' learning related to the daily changes required in nursing care and improved their nursing competency through simulated patient interactions. However, the participants faced difficulties dealing with patients accompanied by secular changes. Moreover, they found remote group work challenging. These findings can be applied to the development of new educational strategies.

Perinatal immunization education improves immunization rates and knowledge: a randomized controlled trial.

OBJECTIVES: To determine if providing perinatal immunization education positively changes the immunization status of infants, influences the infant immunization knowledge, attitudes and beliefs of mothers and affects the intent to vaccinate children in Japan where immunization education is limited. METHODS: Pregnant women were recruited from three sites in Tokyo, Japan and were assigned to two intervention (pre- or postnatal education) groups and a control group. The immunization status of infants was assessed and a written survey was performed before and after the intervention. RESULTS: Among 119 study participants, 106 subjects replied to the post-survey. The intervention groups (34.3%) had higher immunization rates in infants at three months of age than the control group (8.3%) (P=0.005); however, no differences were observed between the prenatal (29.4%) and postnatal groups (38.9%) (P=0.40). The percentage of women intended to vaccinate their infants was higher in the intervention groups (61.4%) compared to the control group (33.3%) (P=0.01). The improvement in score for basic knowledge was higher in the intervention groups, particularly in the prenatal group (mean±S.D.: 3.4±1.8) compared to the control (1.9±1.9) (P=0.003). CONCLUSIONS: Perinatal immunization education improved the immunization status of infants, increased the women's knowledge on immunization and intention to vaccinate their infants.

Post-Migration Changes in Dietary Patterns and Physical Activity among Adult Foreign Residents in Niigata Prefecture, Japan: A Mixed-Methods Study.

The migrant population of Japan is gradually increasing, but it is not well known how and why diet and physical activity (PA) change post-migration. Therefore, this study used a mixed-method approach to investigate the changes in dietary patterns and PA through a web- and paper-based survey (n = 128) and understand the contextual factors for those changes through semi-structured interviews (n = 21). Descriptive and thematic analyses of quantitative and qualitative data were conducted, respectively. The majority of survey (57.8%) and interview (66.7%) participants were female, and the mean duration of stay in Japan was 5 and 3.6 years, respectively. The survey revealed an increased consumption of foods attached to Japanese culture, frozen and microwavable food, and a reduced consumption of fruits. We identified environmental (availability, accessibility, and affordability of foods; food safety and diet-related information; and climate), individual (living status; post-migration lifestyle; and food preferences and limitations), or socio-cultural (relationships with Japanese people; cultural differences; and religious influences) factors that impact diet changes. Language proficiency and the duration of stay shape dietary behaviors. Determinants of PA changes were climate, lifestyle, and the influence of Japanese culture. In conclusion, immigrants in Japan experience post-migration diet and PA changes, and this study adds knowledge about how and why such changes occur.

High rates of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic in Japan.

This study aimed to 1) determine the prevalence and contents of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic and 2) evaluate its association with maternal sociodemographic factors. A cross-sectional survey was conducted between August and December 2020 among pregnant women between 28 and 32 weeks of gestation who received antenatal care at four clinics and hospitals in Niigata City, Japan. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey, and associations between vaccine hesitancy and sociodemographic factors were analyzed. In total, 113/200 (56.5%) subjects responded to the survey. Overall, 46/113 (40.7%) pregnant women were resistant or hesitant to receive the vaccine. Women with vaccine hesitancy were more likely to fear adverse reactions (concern 79.6%, not concerned 15.9%, and not sure 4.4%), safety (concerned 69.0%, not concerned 23.9%, and not sure 7.1%), and efficacy (concerned 47.8%, not concerned 35.4%, and not sure 16.8%) compared to those without vaccine hesitancy (P < .01, < .01, and <.01, respectively). In the multivariate logistic regression analyses, primipara women had higher rates of vaccine hesitancy than multipara pregnant women (odds ratio: 2.38, P = .04). In conclusion, the prevalence of vaccine hesitancy among pregnant Japanese women, especially primipara women, was higher than that in other countries during the COVID-19 pandemic. Their major concerns were adverse reactions, safety, and the efficacy of childhood vaccines. Further strategies are needed to provide appropriate vaccine information to prevent vaccine-preventable diseases in both infants and children.

Evaluation of the first Accelerated Bachelor of Science in Nursing program as a second career in Japan.

BACKGROUND: The first Accelerated Bachelor of Science in Nursing (ABSN) program with a two-year educational period in Japan was developed in a nursing university in Tokyo in 2017 (i.e., 2017-ABSN two-year program or designated as program 1) for individuals aiming to pursue nursing as a second career. It replaced program 2, the second-year bachelor's degree transfer program which is a three-year program implemented from 1997 to 2016. The original and currently on-going four-year undergraduate Bachelor of Science in Nursing (BSN) is designated as program 3. OBJECTIVE: To evaluate the 2017-ABSN two-year program from learners' perspective. METHODS: We used a case-control study design. As cases, the subjects were third-year bachelor's degree transfer students of program 1 at the nursing university in Tokyo. As controls, second-year bachelor's degree transfer students of program 2 and four-year undergraduate students of program 3 in the same university were given a questionnaire when they graduated. The survey items were grouped into five scales: (1) The education you are receiving, (2) Studying nursing, (3) Stress level, (4) The highest score on the national nursing examination practice test, and (5) The vocational commitment. The mean score of each item was calculated and comparisons were conducted using the Mann Whitney test. RESULTS: Responses from 77 students (program 1), 23 students (program 2), and 133 students (program 3) were analyzed. The program 1 students had a significantly lower mean score on (1) The education you are receiving item "There is time for preparation and review" (p = 0.01). The program 1 students had a significantly lower score on (2) The studying nursing item "I can get the job (role) I want" (p = 0.01). The program 1 students had a significantly higher score on (4) The best score in the national nursing examination practice test (p = 0.01). CONCLUSION: Shortening the academic period to two years in program 1 had no effect on the knowledge base of the students. However, the program 1 students had a significantly lower score in their identity as a nurse. It is often difficult to acquire a new nursing culture in a short period from a previous culture that has already been mastered. Educators need to fully understand the characteristics of learners and provide them with individualized and professional guidance to further improve their skills.

Pilot Study of Evaluating Attitudes toward Childhood Immunization among Healthcare Workers in Japan.

Providing appropriate immunization information during the perinatal period is important for improving immunization rates among infants and children; however, the distribution of immunization information by healthcare workers (HCWs) is not standardized in Japan. We investigated HCWs' attitudes toward childhood immunization and factors related to vaccine hesitancy. We conducted a cross-sectional descriptive survey of HCWs involved in childhood immunization in Niigata City, Japan, from November 2017 to January 2018. We assessed contextual, individual and group, and vaccine/vaccination-specific influences. Of 290 HCWs, 139 (47.9%) returned completed questionnaires. Most HCWs (87/139, 64.9%) reported providing immunization information verbally to parents; 51/87 (58.6%) spent fewer than five minutes doing so. Pediatricians provided vaccines based on the parents' best interest, whereas public health nurses and midwives emphasized government policy. Nurses had greater hesitancy related to personal perceptions and social/peer factors than pediatricians (p < 0.001). Nurses were significantly more likely than pediatricians to suggest that children receive more shots than necessary (p < 0.01). Nurses tended to have more negative attitudes toward vaccination and little awareness of immunization promotion compared to pediatricians. Thus, all HCWs involved in childhood immunization should receive sufficient information to provide timely and appropriate immunization to infants and children.

Association Between Real-time Polymerase Chain Reaction Cycle Threshold Value and Clinical Severity in Neonates and Infants Infected With Bordetella pertussis.

BACKGROUND: Polymerase chain reaction (PCR) is highly sensitive and is thus the standard method for diagnosing pertussis. Real-time PCR is widely used because of its accuracy and the simplicity of the simultaneous cycle threshold (Ct) value, which represents the copy numbers of the target gene. Little is known of the association of Ct value with pertussis severity in neonates and infants. METHODS: This study determined Ct values in neonates and infants diagnosed with pertussis by real-time PCR using nasopharyngeal samples at Vietnam National Children's Hospital in Hanoi in 2017 and 2019. The association of disease severity and clinical parameters were analyzed using univariate and multivariate analyses. RESULTS: We evaluated 108 patients with pertussis [median age: 63 days, interquartile range (IQR): 41-92 days]. Only 6/108 (6%) received at least 1 dose of a pertussis-containing vaccine. Among them, 24 (22.2%) had severe disease requiring care in a pediatric intensive care unit, 16 (13.8%) required mechanical ventilation, and 3 (2.6%) died. The median Ct value was lower in patients with severe disease (19.0, IQR: 16.5-22.0, n = 24) than in those without severe disease (25.5, IQR: 20.0-30.0, n = 84) (P = 0.002). Logistic regression analyses demonstrated that PCR Ct value [odds ratio (OR): 1.783, 95% confidence interval (CI): 1.013-3.138, P = 0.045], age (OR: 3.118, 95% CI: 1.643-5.920, P = 0.001), and white blood cell counts (OR: 0.446, 95% CI: 0.261-0.763, P = 0.003) remained significantly associated with severe disease. CONCLUSIONS: Real-time PCR Ct values for pertussis might be useful as a predictor of severe disease in neonates and infants.

Learning experiences and identity development of Japanese nursing students through study abroad: a qualitative analysis.

OBJECTIVES: This study aimed to qualitatively analyze the experiences and perceptions of students at a nursing college in Japan who studied abroad in Asia and North America, thereby identifying the full range of benefits of study abroad programs for Japanese nursing students. METHODS: We conducted a qualitative analysis of the reflection papers and free-response questionnaire items completed by 50 Japanese undergraduate nursing students who participated in 9 study abroad programs in Asia and North America. Content analysis of the data proceeded from typological and deductive to data-driven and inductive, recursively and collaboratively. RESULTS: The results reveal perceived benefits in the areas of English language proficiency and motivation; knowledge of nursing practices, healthcare systems, and global health; cultural awareness and sensitivity; and various types of identity development (second-language motivation and identity, national/ethnic identity, professional identity, identity as a global citizen, and personal growth). It was also shown that students' perceptions of what they learned or gained varied according to the specific characteristics of each study abroad program. CONCLUSIONS: Study abroad experiences are often critical turning points that enhance nursing students' identity formation in the context of multiple and overlapping communities of practice. They also enhance core elements of the educational mission of a nursing college, particularly relating to liberal arts and internationalization. These findings can inform the development of assessment tools to be used in conjunction with study abroad programs at nursing colleges.

Effect of a vaccine information statement (VIS) on immunization status and parental knowledge, attitudes, and beliefs regarding infant immunization in Japan.

BACKGROUND: Because of the overabundance of vaccination information on the internet, in the media, and on social media, providing clear and correct information on immunization is critical for parental decision-making. In 2018, the Japan Pediatric Society created and distributed a Vaccine Information Statement (VIS) to provide appropriate immunization information to caregivers. The objectives of the present study were to evaluate the effect of the VIS on immunization rates, adherence to schedule, and parental understanding of immunization in Japan. METHODS: This cross-sectional study was conducted at 18 centers in 2 prefectures in Japan. Caregivers were assigned to an intervention group, which received the VIS and a questionnaire when their child reached the age of 1 month, and a control group, which received only the questionnaire. Using the self-reported questionnaires, we evaluated vaccination rates and schedule adherence at age 2 months, and parental knowledge, attitudes, and beliefs regarding immunization. Three months later, the questionnaires were returned, and the findings were compared between the 2 groups. RESULTS: We contacted 422 and 428 persons in the intervention and control groups, respectively, and 111/422 (26.3%) and 119/428 (27.8%) returned the surveys. Vaccination rates and adherence rates for the first dose of 4 recommended vaccines did not differ significantly (P > 0.25); however, there were some positive effects on items related to vaccine knowledge (P = 0.03), perceived benefits (P = 0.02), perceived barriers (P < 0.001), and perceived behavioral control (P = 0.01). CONCLUSION: The VIS improved parent comprehension of infant immunization. Future studies should examine if the effects of such an intervention persist and affect vaccine uptake throughout childhood.

Improved parental attitudes and beliefs through stepwise perinatal vaccination education.

This study examined the effects of providing vaccination education during the perinatal period on Japanese parents' knowledge, attitudes, and beliefs about childhood vaccination. A cluster-randomized controlled-trial method was used on a sample of 160 pregnant women recruited from 9 obstetrical sites in Niigata, Japan. The treatment group received a stepwise interactive education intervention, while the control group received a general vaccination leaflet. Changes in parental attitudes toward and beliefs about infant vaccination were assessed on the child's one-month and 6-month birthdays using paper questionnaires. Of the initial 188 participants, 160 (90.4%) completed the final post-survey questionnaire. Scores on injunctive social norms (a morally neutral perception of the behavior of the majority) and descriptive social norms (a moral perception of what individuals should do) significantly increased in the treatment group (p = .02 and p = .01, respectively). There was a significant difference between the 2 groups over time in terms of perceived benefit (efficacy of available preventive actions) (p = .03), but no significant differences in perceived severity (seriousness of a disease outcome), perceived susceptibility (likelihood of getting a disease), perceived benefits, perceived behavioral control, or descriptive social norms between the groups at any time point or in the patterns of change over time (p > .31). Thus, stepwise perinatal vaccination education was found to positively influence maternal attitudes and beliefs about infant vaccination. This study suggests the importance of vaccination education during the perinatal period.

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial.

BACKGROUND: Perinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge. METHODS: In this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention. RESULTS: Among 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p=0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p=0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p=0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p=0.03, p<0.01, and p<0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p=0.02). CONCLUSIONS: Stepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.

Gene expression profile of zeitlupe/lov kelch protein1 T-DNA insertion mutants in Arabidopsis thaliana: Downregulation of auxin-inducible genes in hypocotyls.

Elongation of hypocotyl cells has been studied as a model for elucidating the contribution of cellular expansion to plant organ growth. ZEITLUPE (ZTL) or LOV KELCH PROTEIN1 (LKP1) is a positive regulator of warmth-induced hypocotyl elongation under white light in Arabidopsis, although the molecular mechanisms by which it promotes hypocotyl cell elongation remain unknown. Microarray analysis showed that 134 genes were upregulated and 204 genes including 15 auxin-inducible genes were downregulated in the seedlings of 2 ztl T-DNA insertion mutants grown under warm conditions with continuous white light. Application of a polar auxin transport inhibitor, an auxin antagonist or an auxin biosynthesis inhibitor inhibited hypocotyl elongation of control seedlings to the level observed with the ztl mutant. Our data suggest the involvement of auxin and auxin-inducible genes in ZTL-mediated hypocotyl elongation.

Current practices and needs regarding perinatal childhood immunization education for Japanese mothers.

BACKGROUND: Accurate, standardized information on childhood immunization is not available in Japan. We investigated current practices in perinatal childhood immunization education in the community and the needs and interest for such education among Japanese mothers. METHODS: This cross-sectional, descriptive study evaluated pregnant and postnatal women at four institutions in Niigata, Japan from May through July 2014. Data were collected using questionnaires inquiring about demographics, immunization education received, intent to receive childhood vaccines, and needs regarding information on childhood immunization. RESULTS: Questionnaires were distributed to 300 women, and 116 (38.6%) were returned; 70 (59.6%) of the respondents were pregnant women and 46 (40.3%) were postnatal women. Fourteen (20%) of the 70 pregnant women reported receiving some form of immunization education; in contrast, 34 (73.9%) of 46 postnatal women had received such education within 1 month of delivery. The rates of respondents who felt that the information was insufficient were high: 78.6% among pregnant women and 52.9% among postnatal women. Pregnant women reported that the most important information was general concepts of immunization; in contrast, postnatal women desired more-detailed information, e.g., on immunization scheduling. CONCLUSIONS: Japanese women do not receive sufficient perinatal immunization education. The information needed during the prenatal and postnatal periods differs. Thus, educational approaches may need to provide carefully targeted information.